单孔胸腔镜与双孔胸腔镜治疗原发性手汗的疗效与安全性meta分析

Meta-analysis of the effectiveness and safety of single-hole and double-hole thoracoscopy forthe treatment of primary palmar hyperhidrosis

目的:系统比较单孔胸腔镜与双孔胸腔镜治疗原发性手汗的有效性及安全性。方法:应用计算机检索万方数据库、中国知网、维普网、中国生物医学文献服务系统、PubMed、Web of Science和Embase中关于单孔及双孔胸腔镜手术方法治疗原发性手汗的随机对照或非随机对照临床试验文献,检索时限为2010年1月1日至2022年9月19日。单孔胸腔镜组(单孔组)采用传统腋下单个切口的常规胸腔镜手术,双孔胸腔镜组(双孔组)采用腋下双切口的常规胸腔镜手术。由2名研究者独立检索、筛选文献,提取资料,并采用Cochrane偏倚风险评估工具对纳入研究的随机对照试验文献的质量进行评估,采用纽卡斯尔—渥太华量表(NOS)对纳入的非随机对照试验文献的质量进行评估。采用RevMan5.4.1软件进行meta分析。结果:共检索到935篇文献,经逐层筛选,最终纳入13篇文献,共涉及1 124例患者,其中单孔组556例,双孔组568例。Meta分析结果显示,单孔胸腔镜组切口长度较双孔胸腔镜组短[标准化均数差(SMD)=-4.15,95%CI(-5.41,-2.89),P<0.001]。单孔胸腔镜组手术时间较双孔胸腔镜组所用时间短[均数差(MD)=-5.87,95%CI(-7.52,-4.21),P<0.001]。单孔组患者术后住院时间较双孔胸腔镜组时间短[MD=-0.76,95%CI(-1.18,-0.34),P=0.000 4]。单孔组患者术后疼痛较双孔组患者疼痛轻[MD=-1.31,95%CI(-1.70,-0.93),P<0.001]。2组术后代偿性多汗发生率差异无统计学意义[风险系数(RR)=0.82,95%CI(0.53,1.27),P=0.37]。双孔组患者术后复发手汗发生率较单孔组高[RR=0.26,95%CI(0.07,0.93),P=0.04]。双孔组术后并发症发生率较单孔组高[RR=0.34,95%CI(0.19,0.64),P=0.000 7]。结论:单孔胸腔镜治疗原发性手汗症的安全性及有效性均优于双孔胸腔镜。

Objective:To systematically compare the effectiveness and safety of single-hole and double-hole thoracoscopy for the treatment of primary palmar hyperhidrosis.Methods:The randomized controlled or non-randomized controlled clinical trials of single-hole and double-hole thoracoscopic surgery for primary palmar hyper-hidrosis included from January 1,2010 to September 19,2022 were searched in Wanfang database,China National Knowledge Infrastructure(CNKI),Weipu(VIP),SinoMed,PubMed,Web of Science and Embase.The single-hole thoracoscopic group(single-hole group)was treated with conventional thoracoscopic surgery through traditional axillary single incision,and the double-hole thoracoscopic group(double-hole group)was treated with conventional thoracoscopic surgery through axillary double incision.Two researchers independently searched,screened literature,extracted data,and evaluated the quality of randomized controlled trial(RCT)literature included using the Cochrane bias risk assessment tool.The quality of non-RCT literature included was evaluated using the Newcastle-Ottawa scale(NOS).Meta-analysis was conducted by using RevMan5.4.1 software.Results:A total of 935 literatures were retrieved.After layer-by-layer screening,13 literatures were finally included,involving 1,124 patients,including 556 patients in the single-hole group and 568 patients in the double-hole group.The results of meta-analysis showed that the in-cision length of the single-hole group was shorter than that of the double-hole group[standardized mean differ-ence(SMD)=-4.15,95%confidence interval(CI)(-5.41,-2.89),P<0.001].The operation time of single-hole group was shorter than that of double-hole group[mean difference(MD)=-5.87,95%CI(-7.52,-4.21),P<0.001].The postoperative hospitalization time of patients in the single-hole group was shorter than that in the double-hole group[MD=-0.76,95%CI(-1.83,-0.34),P=0.0004].The postoperative pain in the single-hole group was less severe than that in the double-hole group.[MD=-1.31,95%CI(-1.70,-0.93),P<0.001].There was no significant difference in the incidence of postoperative compensatory hyperhidrosis between the two groups[Risk Ratio(RR)=0.82,95%CI(0.53,1.27),P=0.37].The incidence of postoperative recurrent palmar hy-perhidrosis in the patients undergoing double-hole thoracoscopy was higher than that in the patients undergoing single-hole thoracoscopy[RR=0.26,95%CI(0.07,0.93),P=0.04].The incidence of postoperative complications in the patients undergoing double-hole thoracoscopy was higher than that in the patients undergoing single-hole thoracoscopy[RR=0.34,95%CI(0.19,0.64),P=0.0007].Conclusion:The safety and effectiveness of single-hole thoracoscopy for the treatment of primary palmar hyperhidrosis are superior to those of double-hole thoracoscopy.